Routine inspection·April 7, 2025

On 04/07/2025, Licensing Program Analysts (LPAs) Arielle Pascua and Triel Lindstrom arrived unannounced to this facility to conduct an annual visit. LPAs met with staff member (SM), Remedios De Belen and explained the purpose of the visit. LPA Pascua asked SM De Belen to contact the Facility Designated Administrator (FDA), Bogdan Condor and inform them that CCL was present at this time. Shortly after, LPAs met with FDA Condor and explained the purpose of the visit. The purpose of the visit was to conduct an annual. Current census was 5. A brief interview with FDA Condor was conducted. This facility is licensed to serve and retain 6 elderly residents who all may be deemed non-ambulatory. This facility also has a hospice waiver for 3 and a dementia plan on file. Upon arrival at the facility LPA Pascua rang the ring doorbell located on the right side of the double front doors. After several attempts LPA Pascua knocked on the door and heard an individual on the inside of the facility state that they heard the knock but was unable to open the door. LPA continued to knock on the door 3 more times until the door was opened by facility staff. Upon entrance to the facility both LPAs walked through the double front doors and observed a grey reinforcement locking mechanism above the top lock of the door. LPAs observed that this lock would prohibit the door from being open. Shortly after, LPAs met with FDA Condor and informed him of the lock on the door. LPA Pascua informed FDA Condor that the lock was a safety hazard which prohibited both staff and residents to exit the facility in case of emergency. LPA Pascua asked FDA Condor to take the lock out before the tour of the facility was conducted. During this time, Licensee Voica Matis, arrived at the facility. A tour of the facility was conducted. Fire extinguisher was identified and was last serviced on 02/18/2025 by the local fire extinguisher company. Living room areas, dining areas, and other residents intended for resident use were toured. Furniture and furnishings were observed to be in good repair and able to meet resident needs. Kitchen area was toured. A review of the food supply was conducted to ensure that the facility has a 2 day perishable and 7 day non-perishable food supply to meet the residents needs. Knives were observed to be locked and made inaccessible. LPA Pascua identified one medication cabinet located in the kitchen. Along with Licensee Matis, LPAs reviewed and compared medication with medication dispensing logs. It was learned through review of the facility records that the facility staff had not initialed medication dispensing logs throughout the weekend of 4/4/2025 through today's date of 04/07/2025. In addition, the dates that were initialed were initialed for medication that was supposed to be provided during 8:00pm. LPA Pascua provided assistance to the facility staff and reminded them of the importance of ensuring that medication administration records must be initiated at the time of administration. A review of medication also showed that the facility was pre-pouring medication for the next administration. LPA Pascua stated that the department no longer allowed pre-pouring. Licensee and staff member understood and stated that this would be attended to. First aid kit was also present and contained all the required components. A tour of back yard was conducted. LPAs observed a separate casita in the backyard, which staff use for breaks or live in staff. LPA asked the Licensee send an updated facility sketch to reflect changes. Perimeter fence was observed to be in good repair. The emergency gate was observed, however, upon opening the gate, it was observed that the gate was not easy to open and did not self latch or self close. LPA Pascua advised that the exit gate shall be fixed to ensure that the facility staff and residents were able to open the gate easily and that it would self latch and self close. A tour of the resident bedrooms were conducted. Bedroom #1 has an adjacent bathroom. Bedrooms #2-4 were single occupancy bedrooms. Furniture and furinishings were observed to be in good repair. A tour of the facility bathroom was conducted. Hot water was taken to ensure that it was within 105-120 degrees. LPAs observed rusting on the bottom of the facility shower that may have been from the shower chairs. In addition, black residue was observed in the corners and grout areas of the bathroom shower. A linen closet was identified and contained a sufficient supply of linens to meet the residents needs. A tour of the laundry area was conducted. Cleaning supplies, laundry detergent, and other items were locked and made inaccessible. A tour of the garage was conducted. Additional food supply was identified. LPAs reviewed 6 resident files and 7 staff files was conducted. The administrator has a expired administrator certificate. The following documents were requested to be submitted to the department: -LIC 308 -LIC 400 -LIC 500 -LIC 610E -Updated Facility Sketch -Updated Program Design to reflect staffing such as live in staff -Updated Administrator documentation A immediate civil penalty is being issued today in violation of Section 87202(a). This is due to the reinforcement lock observed at the time of the visit. A technical assistance is being provided for Section 87303(a) and 87465(h)(5). The following deficiencies were observed and cited per California Code of Regulations, Title 22 see LIC 809-D. Exit interview conducted with Licensee and copy of report and appeal rights were left at facility.